A survey of physicians and practice administrators reveals the deep impact of COVID-19 on ambulatory care offices across the country. Online distribution of the survey, conducted by Rockpointe (a leading Continuing Medical Education company) in collaboration with 17 state medical societies, began April 17, 2020. By April 23, responses from 1,244 physician and 190 practice managers from 29 states were included in the analysis. The survey results highlight the need for better access to personal protective equipment (PPE) and for programs to educate clinicians about how to handle COVID-19 cases at their private practices. A manuscript was developed from the results which is available here
Physician and administrator responses indicate COVID-19 will continue to have significant negative impacts on practices well beyond the end of the pandemic. Forty-one percent of responding physicians report that their patient loads have dropped by at least 76% since the pandemic began, and 59% say the number of procedures they perform has fallen by at least 76%. The vast majority of private practices have applied for government-funded assistance during the pandemic: 81% of administrators report applying for government assistance for small businesses, and 62% say they have received an emergency payment or deposit from CMS. Many physicians report cutting their office staffs by at least half, and 15% have closed their practices either permanently or temporarily; another 20% are unsure whether they would close. A majority, 53%, say they are very or extremely concerned about the long-term negative effects of the pandemic on their practices.
Access to PPE has become an issue for private practices. Fifty-six percent of physicians reported having only a two-week supply or less of standard PPE, and practice managers reported an equally meager supply of standard types of equipment. N-95 respirators are reported to be in short supply at 84% of practices, followed by gowns and surgical masks (57%), hand sanitizers (43%), disinfectant/sanitizers (42%), and gloves (27%). Sixty-one percent of physicians reported use of PPE by clinical staff, clerical staff, and patients; whereas 22% reported use only by clinical staff.
As patient loads and office visits diminish amid social distancing efforts, private practices are increasingly turning to telemedicine, primarily using general public social media. Whereas 87% of physicians did not use telemedicine to conduct patient visits before the pandemic, 83% reported doing so now, with 47% saying they now conduct at least half of their visits via telemedicine. Physicians say patients are receptive, with only 7% seeming to be unfavorable to conducting visits this way. Telephone visits appear to be an equally popular alternative: 39% of physicians say at least half of their visits are by phone, versus 40% saying at least half are through the Internet. Administrators indicated the most popular platforms for patient visits by telemedicine are Zoom (30%), Facetime (26%), eClinicalWorks (9%), OTTO Health (5%), eVisit (3%), and Skype (3%). Only 13% of office managers reported connectivity issues, but 27% of physicians and 29% of administrators say they have had difficulty obtaining reimbursements for visits conducted via telemedicine.
The need for education is real and urgent across all specialties that are managing patients in the outpatient setting. Based on the survey responses and recent literature, clinicians need continuing education that addresses multiple aspects of patient care in the setting of the COVID-19 pandemic, including:
- Sufficient knowledge of the epidemiology and pathophysiology of SARS-CoV-2.
- General guidelines for mitigating risk of COVID-19 infection in the practice setting.
- Guidance specific to the individual specialties that manage patients in the outpatient setting.
- Implementing telemedicine into patient care, including available platforms, documentation, reimbursement, and patient engagement.
- Strategies for effective patient communication regarding pandemic-related issues.
- Approaches for management of COVID-19 patients in special populations.
Study authors included, Terry Ann Glauser, MD, MPH, Rockpointe; Chad Williamson, MS, MBA, Rockpointe; Leanne Berger, BS, Rockpointe; Sharon Hwang, MD, MPH, Med Matters, LLC; Frank C Berry, BS, MedChi; C. Michael Gibson, MS, MD, Baim Institute; Thomas P Sullivan, BS, Rockpointe
Through effective continuing medical education (CME), PCME parent company Rockpointe strives to improve and advance the quality of patient care. Its educational programs have been at the forefront of new issues in healthcare, including implementing MACRA, combating the nation’s opioid and vaping crises, and providing timely, accessible COVID-19 education and resources to healthcare providers.
As part of its commitment to quality, Rockpointe works to inform the continuing-education community of significant quality-improvement issues through news and analysis on Policy and Medicine. In addition, its popular Medical Education Exchange (MEDX) CME medical educational conferences include sessions on the basics of quality improvement, as well as relevant, scientifically-accurate sessions on numerous disease states.